vitamin-b-12 and Fatigue-Syndrome--Chronic

A tailor-made management plan that includes various combinations of non-pharmacologic and pharmacologic therapy for patients with chronic fatigue syndrome (CFS) is important. We present an overview of four aspects of our medical treatment and management for CFS: introduction of our medical management system, summary of our management strategy, non-pharmacologic therapy, and pharmacologic therapy; according to foreign guidelines and the latest studies. The main non-pharmacologic therapies for CFS are rehabilitation and lifestyle guidance. Using a graded exercise therapy, we have constructed a broad management strategy for CFS. Herein we introduce our graded exercise therapy. If the symptoms continue despite careful management of the program by the physician, consultation with a psychiatrist or psychosomatic medicine specialist is necessary.

Topics: Ascorbic Acid; Cognitive Behavioral Therapy; Exercise Therapy; Fatigue Syndrome, Chronic; Humans; Life Style; Practice Guidelines as Topic; Psychotropic Drugs; Referral and Consultation; Severity of Illness Index; Vitamin B 12

Chronic fatigue syndrome in childhood and adolescents(CCFS) is a complex and debilitation with severe morbidity and confusion. It is common condition with up to 3-5% of children and adolescents showing strange fatigue and confusion for more than 30 days. In this condition, four major symptoms are important: sleep disorders, easy fatigability, disturbed learning and memorization and immunological problems. Routine laboratory studies are similar to adult CFS, although abnormalities can be seen on serum pyruvic acid level, OGTT pattern, deep body temperature rhythm, hormonal secretion rhythm, and cerebral blood flow. For a diagnosis of CCFS, a research group supported by Japanese ministry of health, labor and welfare developed CCFS case definition on 2004. Treatment focused to correct disrupted circadian rhythms and supply of energy.

Topics: Adolescent; Child; Drugs, Chinese Herbal; Fatigue Syndrome, Chronic; History, 20th Century; Humans; Hyperthermia, Induced; Melatonin; Phototherapy; Reference Standards; Selective Serotonin Reuptake Inhibitors; Vitamin B 12

In a randomized, placebo-controlled double-blind trial a combination of lofepramine, phenylalanine and vitamin B(12) was found to be effective in relieving the symptoms of multiple sclerosis (MS). The effect occurred within 2-4 weeks, and improved all types of symptoms in all types of MS. The combination was also effective in relieving symptoms in patients with chronic pain and chronic fatigue. We hypothesize that the action of this combined therapy may relate to activation of the noradrenergic locus coeruleus/lateral tegmentum (LC/LT) system which has the potential to influence the functioning of large areas of the brain and spinal cord.

Topics: Adrenergic Fibers; Adrenergic Uptake Inhibitors; Antidepressive Agents; Chronic Disease; Double-Blind Method; Drug Therapy, Combination; Fatigue Syndrome, Chronic; Humans; Locus Coeruleus; Lofepramine; Methylation; Multiple Sclerosis; Norepinephrine; Pain; Phenylalanine; Severity of Illness Index; Stroke; Stroke Rehabilitation; Tegmentum Mesencephali; Treatment Outcome; Vitamin B 12

Chronic fatigue syndrome is a heterogeneous condition with as proves effective treatment. I present two case reports in which N of 1 trials helped me make management decisions. High-dose vitamin B12 injections were ineffective in one case; nimodipine was very effective in the other case.

Topics: Adult; Calcium Channel Blockers; Cross-Over Studies; Decision Support Techniques; Double-Blind Method; Fatigue Syndrome, Chronic; Female; Humans; Middle Aged; Nimodipine; Vitamin B 12

Chronic fatigue syndrome is a recently defined entity for which clinical criteria were proposed by the Centers for Disease Control, Atlanta, Ga. A frequently advocated treatment in Southern California is an injectable solution of bovine liver extract containing folic acid and cyanocobalamin (LEFAC). We conducted a double-blind, placebo-controlled, crossover trial of intramuscular LEFAC in 15 patients who met the Centers for Disease Control criteria for chronic fatigue syndrome. Although patients responded to placebo and LEFAC by several criteria of functional status, no significant difference was apparent between response to placebo and that to LEFAC. The placebo response appeared to be strong.

Topics: Adult; Double-Blind Method; Drug Combinations; Fatigue Syndrome, Chronic; Female; Folic Acid; Humans; Liver Extracts; Male; Middle Aged; Randomized Controlled Trials as Topic; Vitamin B 12

Topics: Fatigue Syndrome, Chronic; Fibromyalgia; Folic Acid; Humans; Vitamin B 12

Patients with myalgic encephalomyelitis (ME, also called chronic fatigue syndrome) may respond most favorably to frequent vitamin B12 injections, in vital combination with oral folic acid. However, there is no established algorithm for individualized optimal dosages, and rate of improvement may differ considerably between responders.. To evaluate clinical data from patients with ME, with or without fibromyalgia, who had been on B12 injections at least once a week for six months and up to several years.. 38 patients were included in a cross-sectional survey. Based on a validated observer's rating scale, they were divided into Good (n = 15) and Mild (n = 23) responders, and the two groups were compared from various clinical aspects.. Good responders had used significantly more frequent injections (p<0.03) and higher doses of B12 (p<0.03) for a longer time (p<0.0005), higher daily amounts of oral folic acid (p<0.003) in good relation with the individual MTHFR genotype, more often thyroid hormones (p<0.02), and no strong analgesics at all, while 70% of Mild responders (p<0.0005) used analgesics such as opioids, duloxetine or pregabalin on a daily basis. In addition to ME, the higher number of patients with fibromyalgia among Mild responders was bordering on significance (p<0.09). Good responders rated themselves as "very much" or "much" improved, while Mild responders rated "much" or "minimally" improved.. Dose-response relationship and long-lasting effects of B12/folic acid support a true positive response in the studied group of patients with ME/fibromyalgia. It's important to be alert on co-existing thyroid dysfunction, and we suspect a risk of counteracting interference between B12/folic acid and certain opioid analgesics and other drugs that have to be demethylated as part of their metabolism. These issues should be considered when controlled trials for ME and fibromyalgia are to be designed.

Topics: Analgesics; Fatigue Syndrome, Chronic; Female; Fibromyalgia; Folic Acid; Genotype; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Prescription Drugs; Vitamin B 12

Given previous findings, we wished to investigate whether there was evidence of autonomic dysfunction in patients with chronic fatigue syndrome, and whether this could be related to reduced erythropoietin levels and altered red blood cell indices.. We assessed autonomic function and analysed blood parameters (including erythropoietin) in 22 patients with chronic fatigue syndrome who were medication-free and without comorbid depression or anxiety. Results were compared to 23 iron-deficiency anaemia patients and 18 healthy individuals.. Autonomic testing in patients with chronic fatigue syndrome yielded a significantly greater increase in heart rate together with a more pronounced systolic blood pressure fall on standing compared to healthy individuals. Heart rate beat-to-beat variation on deep breathing and responses to the Valsalva manoeuvre were normal. Two of 22 patients with chronic fatigue had mild normochromic normocytic anaemia with normal ferritin, vitamin B12 and folate levels. Serum erythropoietin levels were within reference range.. Some autonomic dysfunction is present in chronic fatigue syndrome (CFS) patients; the explanation remains uncertain, but could relate to cardiovascular deconditioning. There were no major haematological, biochemical or immunological abnormalities in these patients.

Topics: Adult; Albumins; Autonomic Nervous System; Blood Pressure; Creatinine; Erythropoietin; Fatigue Syndrome, Chronic; Female; Heart Rate; Humans; Male; Middle Aged; Severity of Illness Index; Surveys and Questionnaires; Valsalva Maneuver; Vitamin B 12

Topics: Fatigue Syndrome, Chronic; Humans; Vitamin B 12

Topics: Fatigue Syndrome, Chronic; Humans; Injections; Vitamin B 12

Topics: Evidence-Based Medicine; Fatigue Syndrome, Chronic; Humans; Physician-Patient Relations; Research; Vitamin B 12

Topics: Fatigue Syndrome, Chronic; Humans; Injections, Intramuscular; Vitamin B 12; Vitamin B 12 Deficiency

A Johns Hopkins University study reveals that HIV-infected men with abnormally low B vitamin blood levels progressed to AIDS twice as fast as those with normal levels. Low levels of B12 have also been found in persons with Chronic Fatigue Immune Dysfunction Syndrome (CFID). Since both ailments have a common virus in HHV-6A, the virus is suspected, although unproven, of causing the inability of the intestines to absorb B12 by affecting intrinsic factor levels.

Topics: Acquired Immunodeficiency Syndrome; Cognition Disorders; Fatigue Syndrome, Chronic; Herpesvirus 6, Human; Humans; Intrinsic Factor; Vitamin B 12; Vitamin B 12 Deficiency

Twelve outpatients, all women, who fulfilled the criteria for both fibromyalgia and chronic fatigue syndrome were rated on 15 items of the Comprehensive Psychopathological Rating Scale (CPRS-15). These items were chosen to constitute a proper neurasthenic subscale. Blood laboratory levels were generally normal. The most obvious finding was that, in all the patients, the homocysteine (HCY) levels were increased in the cerebrospinal fluid (CSF). There was a significant positive correlation between CSF-HCY levels and fatiguability, and the levels of CSF-B12 correlated significantly with the item of fatiguability and with CPRS-15. The correlations between vitamin B12 and clinical variables of the CPRS-scale in this study indicate that low CSF-B12 values are of clinical importance. Vitamin B12 deficiency causes a deficient remethylation of HCY and is therefore probably contributing to the increased homocysteine levels found in our patient group. We conclude that increased homocysteine levels in the central nervous system characterize patients fulfilling the criteria for both fibromyalgia and chronic fatigue syndrome.

Topics: Adult; Cystathionine; Fatigue Syndrome, Chronic; Female; Fibromyalgia; Homocysteine; Humans; Methionine; Middle Aged; Models, Biological; Vitamin B 12

Topics: Acyclovir; Antidepressive Agents; Behavior Therapy; Centers for Disease Control and Prevention, U.S.; Diagnosis, Differential; Endocrine Glands; Exercise; Fatigue Syndrome, Chronic; Fatty Acids, Essential; Humans; Immunoglobulins, Intravenous; Sleep; United States; Vitamin B 12